Since the earliest characterization of the signs and symptoms
of venous congestion in a child with a ventricular septal defect, it has been recognized that the causes of heart failure
in children are multifactorial and not limited to the presence
of left ventricular dysfunction. Heart failure in children
results from etiologies as diverse as volume overload, pressure
overload, cyanosis, primary myocardial disease of either
or both ventricles, metabolic abnormalities, and genetic
mutations. Mechanistic insights into the pathophysiology of
heart failure in children, coupled with a molecular understanding
of cardiac development, have the potential to identify
new therapeutic targets for the treatment of all patients
with heart failure.
The absence of accurate disease-specific incidence and
outcome data are an impediment to research on pediatric
heart failure. The European experience illustrates the potential
contributions of systematic national databases for pediatric
care in general and pediatric heart disease in particular.